St. Joseph-Hoag alliance manager grapples with controversy

Richard Afable, CEO of the St. Joseph-Hoag group, known as the Covenant Health Network, outside his Irvine offices. MICHAEL KITADA, ORANGE COUNTY REGISTER

Richard Afable, the man who runs the newly-formed alliance between Hoag Hospital and St. Joseph Health, faces some formidable challenges four months into the project. He must mesh two very different corporate cultures, even as he struggles to convince skeptics that St. Joseph, a Catholic health system, is not a dominant partner in the relationship with Hoag, which is Presbyterian.

Hoag's decision to ban elective abortions, communicated to its medical staff two months ago, has hardly facilitated Afable's public relations task. The ban continues to generate controversy and confusion, as Hoag doctors struggle to interpret its scope and California's Attorney General, Kamala D. Harris, investigates its impact on patients.

Afable was CEO of Hoag when the deal with St. Joseph was being negotiated, and by his own account was "the person most responsible for the decisions that were made" leading up to it. Afable has executed some notable linguistic pirouettes of late in his attempt to dispel the widely-held notion that Hoag's decision to stop performing elective abortions was imposed on it by St. Joseph, which forbids them.

In an interview earlier this month, Afable repeated Hoag's official version of events, saying the hospital had reviewed all of its services when it began considering a possible affiliation with St. Joseph and had decided that it performed too few abortions to ensure the standard of quality to which it holds itself. By the time Hoag sat down to negotiate concrete partnership details with St. Joseph, he said, it was not a point that needed to be discussed.

However, Afable appeared to contradict himself when the Los Angeles Times quoted him saying that St. Joseph had made clear to Hoag the abortion ban was "sacrosanct" and "required of ourselves and anyone we would work with."

In a subsequent interview last week, Afable disassociated himself from those quotes.

"I do not recall making that statement whatsoever. And I wouldn't have, because it's not a true statement," he told the Register. What was not true about it, he said, was that St. Joseph had pressured Hoag in any way.

He conceded that he had known all along Hoag would have to stop performing elective abortions if it were to enter into the alliance with St. Joseph. But the decision to stop doing them, he claimed, had nothing to do with that.

"If Hoag had not determined independently to discontinue abortions, on clinical grounds, St. Joseph would not have been able to consummate the affiliation," Afable said.

At a meeting Thursday in Hoag's obstetrics/gynecology department, doctors and hospital administrators discussed guidelines for interpreting what is meant by "elective abortion." Allyson Brooks, executive medical director of Hoag's Women's Health Institute, said the group had agreed on updated rules that will "preserve the physician-patient relationship and the ability to do what they need to do for the health and safety of their patients."

Meanwhile, some Hoag doctors have been contacted recently by the state Attorney General's office, which is investigating whether the hospital has complied with the conditions on which Harris approved the affiliation. Lisa Abaid, a gynecologic oncologist who practices at Hoag, said she got a call from an official in the AG's office who asked "when I was made aware of the ban and what I was told back in September about any changes in services that would take place as a result of the merger."

Hoag said in a statement it was "cooperating and responding to any and all AG inquiries regarding Hoag's compliance with the conditions the AG imposed on its consent to the affiliation."

In her February approval letter, Attorney General Harris said Hoag could stop performing abortions if it adopted St. Joseph's "statement of common values" – which it did – but that it must "still take steps to ensure that alternative providers are available and accessible to all women, especially low-income women."

Afable said he hoped to enter into a "formal relationship" with Planned Parenthood to perform that function for Hoag. He also pledged that the hospital would continue indefinitely to perform other women's services banned at St. Joseph hospitals, including birth control and fertility procedures – even though Harris only required that they continue for 10 years.

"That will never stop," Afable said. "I stake my full reputation on that."

But Abaid voiced the skepticism of some of the doctors on Hoag's staff. "He was the same guy who told us in the fall that it would be business as usual and that no business practices would be changed by the merger," she said.

Hoag has become something of a flash point in the abortion debate of late. Groups favoring and opposing abortion rights rallied outside of the hospital earlier this month. On Thursday, anti-abortion activists scribbled graffiti on the sidewalk outside the office of a Hoag-affiliated obstetrician/gynecologist, Abaid said. That night, they protested outside the same doctor's home.

Related Links

Richard Afable, CEO of the St. Joseph-Hoag group, known as the Covenant Health Network, outside his Irvine offices. MICHAEL KITADA, ORANGE COUNTY REGISTER
Hoag Hospital in Newport Beach recently merged with the Catholic-affiliated St. Joseph Health. Hoag, which has Presbyterian origins, has drawn heat for its decision to ban elective abortions. CHRISTINE COTTER, ORANGE COUNTY REGISTER

1 of

User Agreement

Keep it civil and stay on topic. No profanity, vulgarity, racial
slurs or personal attacks. People who harass others or joke about
tragedies will be blocked. By posting your comment, you agree to
allow Orange County Register Communications, Inc. the right to
republish your name and comment in additional Register publications
without any notification or payment.